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SITE.WORK DATE tD/srG..COMMENTS OWNER AUILDER DEI,CAR TION <br />I hmby ain"n und€r D..ally or pajuir lnal I &n crcDpl from thc conlraclou Lic.ns. Lav lor rh. follo$'in8 rmn (S( 701 1.5 <br />Ausi!6s ald PmlBion cod.): Any (iry or Counry whi.h r.quns t lmil lo an{rucr alro. inProve dmolish or r.pan &v <br />studsq p.io! ro ils is@cc. aLo i.qun6 lh. appli.er for such Fnil to fiL a signcd dmal lhal he or sh. b licdcd PuEu l <br />ro rhc rovisios olrhc Connacbai Li.cn*d liw (Chao( 9. Commcncins wilh Sdlio. ?000 of Division I oflh. Busincss md <br />ProlsionsCodc)orlharl€orsncis.xciflrhG.ftonmdrheb6istortheallcgal.rdnFion.Anyri.lalio,ofs.{lion?0115bvanv <br />flrph(snrlorap<rD'lsuhr((rh(,pplndtosurrlpcnah)o,nolmo,.rh fivc hund.d dollar l5r00,,//. . <br />4lS * "*..r'r," p,.p-,r. or m' cmpro)6 * h s as6 s rheir elc comps&rion. *iI do rhc $olt ud rh. trME is f,or <br />-intm(k or oficred fo. ele (s6 7044, Bci.e ed Itolsions Code Thc co.rracloi$ Lico* Ii* dod nor aPplv ro u oMr 6i <br />nE pmpdry who hilds or imprcv61h@[ od who doe such s* hin*clf or hd*lt ot l]mulh his or ha own e'nplot.6. <br />polid.d d su.h inprovmG e @r iddd.i o. olldcd for sL lt ho\6a. rhe tnildins or imFo\od b $h f,nhh onc yw <br />ofNmplction. rhc Ownd Build6 will hrvc lhe llrdd otFrovin! rh,t he or she did nol hrild or impNlc th. pmpdv lor rhc plrpos oa <br />-1. <br />sown$oflh. propclr. dn.xdusnelyco raclinS wnh licmed .o.lmclo6 ro conerud lhe pmjcct (Sc ?044. B6ins <br />.nd Prof6sion Code: 'rhc contidoa s Licftse Law dos nol applylo a ownn oaPropcny wno burldr o. ntProrq thd@n, <br />and who.otua.ElorsuchpiojElssilhECo.rDcro($lic.ns.druumttolheconracloisLicaslr*). <br />_l <br />K"" <br />I <br />BES4AAj,! <br />I hcrcb! sftinn undo pcmn! of pdjuryo.eof lh. tollowins d.clear66: <br />-lhav.ddrvillmainleinaCcnificar€olconsrrosclfinsur€lorsork.6conP.ns.lion,6providcdforbysslionlT00ollhcLrbor Codc. ior rhc pdfomdc. ollfi€ wo lor which llt Ftuit ir isued. <br />-l <br />h.v.and will'nii oin wo'ke4' co'nptuaridn insdr.n.., 6 reqrted by S(r ion r T00 oflhc l,alrr Code, aor rh€ ptrfomance ol <br />rh. wort lor shich thl"s pmil is ised My qor*6t comp€nsrion iNurdce.eid 5d policy nunlbo d.: <br />Policy Nunrbs r-[rpi'.s: <br />I ccnirylhar in lh. pdfoflname oilhc work lor uhi.h lhis l).mi is issued. I shalln.r mplot &t P6on in anv dend <br />e ero bdo,ne subid ro rhs sr*6 co,npeddio. Lss ofcalifomia. ud as@ thal ifI should betoiE sbid to rh€ <br />\ro&d' conDdsrion prcvisioN or S..rion l70ooirh. tjbor Code.Ishall- aonhsth comply sith lhoe piovbnrns <br />WARNINCT Failurc lo suc Norlds co,npenslio! covmr. n u.b*ful, aad shall subj.r e onplovd to ojoinal Fahi6 d <br />lo one hundred lhousand dollaF ($100.000), r addnion to lnc or.ofrc.sario.. dama!6 6 l,mlidcn for rh€ <br />( ode im.r6t and ihorfty'3 rd <br />"4-9 <br />DIq.AAAI'ON <br />I hcEby amnnonda pdal, ofpsjury rhal I @ li.dr.d udd pmvision ofchapls I (comndcing Nilh Seclion 7000) orDivision 1 <br />of rhc Bsind dd Pma*io6 Codc,.nd,ny licor is in luu aor.c ed.fid. <br />loN$alljlor[Elll8c-acENcr <br />I h.Eby flrmn xndo pcnally ol p.rjtrry rhor $q. is a conslrucl ion lodins t!6cy lor lhc psfonn&c. of lhc vort ior vhich lhis Fmit is <br />iss!.d (sd. 1097, civ c.). <br />I.nl.'r\Mr- <br />L.nJ.' l AJia <br />- <br />AIIUCA.NfDECIAAAIIOtr <br />I hdd,y .lrm uidd pcoalty of Fjury o.c .a rh. folloNin8 dNldal ioni <br />D€nolnion Pdmns-Asbctos Nolifi calion Feddal R.Sulaiions (Iilk a0- Pan6) <br />Rertun.d tar€r of Nolifcilio. <br />-l <br />cdity llBl rh. a.ddal rcsulalioE Esadins Bhsros dnolal ee nol Epplicabl. b rhis pBj..l <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing 1Jtt/ty 5\'6< <br />lnsulation/Enerqy <br />Drwvall l/L/ 4 a<a <br />Ext./lnt. Lath I <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL t/ tLt/ t1 )\ft <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />x <br />) <br />BUdDING- INSPECTOR RECORD <br />&/,"-B <br />T <br />-T